National Center for Health Statistics NCHS Vital Records

National Center for Health Statistics (NCHS) Vital Records Birth and Fetal Death Reporting FHIR Implementation Guide June 15, 2020 © 2019 Lantana Consulting Group / www. lantanagroup. com

Agenda • • Birth Defects Reporting IG alignment Composition resource • FHIR IG: https: //trifoliafhir. lantanagroup. com/igs/lantana_hapi_r 4/hl 7 -fhir-usbfdr/index. html

Main Participants - FHIR Profiles (subject to change) § NEWBORN » BFDR_Patient_Newborn § MOTHER » BFDR_Patient_Mother » BFDR_Related. Person_Mother • Data duplication (name, address, etc. )? • As little as possible duplication – Zulip? • Implementation specific – must support but not required. § FATHER » BFDR_Patient_Father » http: //www. hl 7. org/fhir/patient. html#maternity 3

Main Participants - In the case of Fetal Death – would the fetus get a Patient resource and Encounter? - Two ways to model the fetus § Fetus is a Patient § Fetus has their own Encounter (delivery encounter) created, same as a Newborn § OR § Fetus is the focus of a set of observations, but the mother is the subject § No patient created for the fetus § No encounter created for the delivery (other than the already existing mother’s encounter) » Would mean that all demographic data usually represented by data elements on the Patient resource (deceased. Date. Time, name, birthdate, birth sex, etc. ) would need to be represented by Observations 4

Common Data Elements BDR/BFDR • Participants - Newborn/Fetus - Mother - Father • Observations - Observation - Place Of Birth Observation - Parent Education Level Observation - Infant Living Observation - Autopsy Performed Observation - Parent Education Level Observation - Mother Risk Factor Observation - Mother Labor Onset (BDR) Observation - Prenatal Care Observation - Number of Mother Births Now Living - Observation - Number of Mother Outcomes - Observation - Prior Cesareans - Observation - APGAR Score - Observation - Plurality 5 - Observation - Mother Height Observation - Mother Pre-Pregnancy Weight Observation - Mother Delivery Weight Observation - Birth Weight Observation - Gestational Age Observation - Mother Last Menstrual Period

Common Vital Records IG? • Birth Defects Reporting and Birth and Fetal Death Reporting have very similar timelines (Connectathon in Sept and Ballot in January). • Much overlap in data • Would like to use the same profiles in both IGs • Options: - BFDR re-uses/references/derives from BDR profiles (or vice versa) - Create a common Vital Records IG containing all the common profiles - Create duplicate profiles in the separate IGs • Challenges - IGs are in development – difficult to reference other IGs that are not published Responsibility for a common Vital Records IG Management of changes over lifecycle Publication timelines / updates • Zulip thread: https: //chat. fhir. org/#narrow/stream/179166 implementers/topic/Common. 20 profiles. 20 across. 20 multiple. 20 IGs 6

Composition/Encounter • • Working on overall structure of IG Composition? Something else? Composition. encounter -> Encounter_Baby. part. Of -> Encounter_Mother Encounter. participant -> Mother, Father, Informant, Certifier, Attendant, etc? Composition. section -> Mother’s Info, Father’s Info, Labor & Delivery, Vitals, etc? • IHE uses Composition, but lacks detail (no information on Sections, contained resources etc. ) • IHE Need clarification: IHE part. Of. Encounter. Resource - Is this the newborn/fetus? - FHIR spec indicates that the newborn/fetus Encounter is part. Of the mother Encounter § i. e. part. Of. Encounter. Resource = Mother § http: //www. hl 7. org/fhir/patient. html#maternity 7